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Ế
CH T L
NG KHU V C
Ấ ƯỢ
ƯỜ
Ự
PHI U ĐI U TRA Ề NG MÔI TR LÀNG NGH G M PHÙ LÃNG Ề Ố
Ng i ph ng v n........................................................ ườ ấ ỏ
Th i gian ph ng v n: Ngày tháng năm 200... ấ ờ ỏ
THÔNG TIN CHUNG
1. H tên ng i cung c p thông tin:... ................................................................... ọ ườ ấ
Ch ký......................... ............................................................................................ ữ
ệ ổ ớ
ề ộ ộ
ệ ỉ
ạ
i tính................... 2. Ngh nghi p:...................................................tu i.............gi Trình đ văn hoá..............................Dân t c.......................................................... 3. Đ a ch : ỉ ị Thôn......................Xã:........................huy n.........................T nh.......................... 4. S đi n tho i:...................................................................................................... 5. S thành viên trong gia đình:...............ng ố ệ ố i ườ
6. Thu nh p bình quân c a gia đình Anh (Ch ) hi n nay m i tháng đ c bao ủ ệ ậ ỗ ị ượ
nhiêu?:………….........................................................................................................
A - Đ I V I H GIA ĐÌNH LÀM G M
Ố Ớ Ộ
Ố
1.Gia đình làm ngh này lâu ch a? Qua bao nhiêu th h ? ế ệ ư ề
...........................................................................................................................
........................................................................................................................... ........................................................................................................................... ...........................................................................................................................
2.S nhân công làm trong gia đình? ố
...........................................................................................................................
+Có ph i thuê thêm ng i không? ả ườ
Có Không Thuê toàn bộ
+S l ng là bao nhiêu ng i? ố ượ ườ
................................................................................................................................. i/ tháng? +Tr cho h bao nhiêu ti n/ng ườ ề ả ọ
bên ngoài , xây d ng, có s h tr v n t ả ự ầ ư ự ỗ ợ ố ừ
ả ấ ồ ữ ạ
................................................................................................................................. 3.Quy mô s n xu t (kinh phí đ u t ấ không?...) ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 3.Quy trình s n xu t g m nh ng công đo n nào? ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. .................................................................................................................................
ồ ệ ữ
đâu)? ị ấ ể ệ ấ ừ
ộ ầ ả ng c th )? ụ ể ố ượ ử ụ ệ ấ
ử ụ ả ấ ạ ấ
đâu? c dùng cho s n xu t l y t ả ấ ấ ừ ồ ướ
ả ự ế ướ ử ả ả
4.Nguyên li u g m nh ng gì? ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. +Đ a đi m l y nguyên li u(l y t ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. +M t l n s n xu t thì s d ng bao nhiêu nguyên li u( s l ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 5.+Trong quá trình s n xu t có s d ng lo i hóa ch t nào? ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 6.+Ngu n n ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. +N c th i th i ra đâu? Th i tr c ti p hay qua x lý? ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ...............................................................................................................................
ấ ồ ữ ả ả
7.Các lo i ch t th i chính sau s n xu t g m nh ng gì? ấ X than,tro b i ụ Sành xứ
• Lo i khác................................................................................................. ạ ỉ ạ
ạ
Than.
8.Gia đình s d ng lo i lò nung nào? ử ụ Lò nung ga. Lo i khác: ạ
…..................................................................................................... ệ
c lò? ướ
ự
ờ ầ
ị ộ ồ ả
ắ
đâu?có đ ng tiêu th c a s n ph m ụ ủ ả ẩ ở ượ ấ ẩ
đây nh th n o? ng ư ế ả ườ ệ ả ạ ở
9.+Di n tích,kích th ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. +Chi phí xây d ng lò? ................................................................................................................................. ................................................................................................................................. 10.Th i gian 1 l n nung là bao lâu? ................................................................................................................................. ................................................................................................................................. 11.Trong quá trình nung ,anh(ch )có s d ng đ b o h gì không?( găng tay, ử ụ kính m t,kh u trang,…) ẩ ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 12.Th tr ổ c xu t kh u không? Có n ị ườ đ nh không? ị ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 13.Gia đình c m th y hi n tr ng môi tr ấ + Đ t ấ ...................................................................................................................... ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. + N c.ướ ................................................................................................................... ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. + Không khí............................................................................................................. ................................................................................................................................. ................................................................................................................................. .................................................................................................................................
ễ ế
t nào th ng xuyên x y ra? ị ả
ệ
ạ ệ B nh đau m t h t B nh khác. ệ ệ
ng có th ng xuyên quan tâm đ n các v n đ môi ề ươ ườ ế ề ấ
ị ng c a làng ngh không? ủ ườ
ế ề ả ớ ị ị
ng không?........... ườ
ồ ................................................................................................ +Ô nhi m ti ng n: ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. +Khác...................................................................................................................... ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 14. Trong gia đình anh (ch ), lo i b nh t ườ ậ B nh hô h p. ắ ộ ấ ............................................................................................... ................................................................................................................................. 15.Chính quy n đ a ph tr ề ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. -Anh (ch ) có ki n ngh gì v i chính quy n đ a ph ng và cán b qu n lý môi ộ ươ ị ............................................................................................. tr ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. .................................................................................................................................
Ố Ớ Ộ
Ố
1.Môi tr có ô nhi m nh ng gì? ườ
B. Đ I V I H GIA ĐÌNH KHÔNG LÀM G M ng xung quanh n i Anh(Ch ) ị ở
ữ ễ ơ
ng Đ t:……… ấ ườ
ng không khí:……….. ườ
ng n c:…… ướ ườ
ồ ễ
ng c a các ho t đ ng s n xu t làm ứ ộ ạ ộ ủ ả ả ấ
ố ớ ứ
ng t ố ớ ả ấ ớ
ạ ộ ấ ủ ả ộ
........................................................................................ -Môi tr ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ............................................................................ -Môi tr ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. .......................................................................................... -Môi tr ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 2.Các ngu n gây ô nhi m? ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. 3.Anh( ch ) đánh giá m c đ gây nh h ị ưở g m nh th nào? ư ế ố ............................................................................................. -Đ i v i s c kh e: … ỏ ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. -Đ i v i các ho t đ ng s n xu t khác( nh h i buôn bán kinh doanh, các ưở ả ....................................................... quá trình s n xu t c a các h gia đình khác): ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. .................................................................................................................................
ở ả ự ườ ự ố ề ng? S y ra ả
ng? ứ ộ ả khu v c mà anh (ch ) s ng có x y ra s c v môi tr Ở ưở ư ế
ị ị ớ ế ề ươ ả ị
ng không?........... ườ
................................................................................................................................. ................................................................................................................................. 4. đâu? ị ố Nh th nào? M c đ nh h …………................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ng và cán b qu n lý môi 5.Anh (ch ) có ki n ngh gì v i chính quy n đ a ph ộ tr ............................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. .................................................................................................................................
NG
Ố Ớ
Ị
ƯƠ
C.Đ I V I CHÍNH QUY N Đ A PH (không có trong b ng câu h i)
Ề ả
ỏ
ị ệ
ế
ệ ả ệ
ng đ n vi c phát tri n làng ngh ? ề ưở ể
1.Di n tích?V trí đ a lý? ị 2.Kinh t ? văn hóa? Xã h i? ộ 3.Bao nhiêu h và doanh nghi p s n xu t g m s ? ứ ộ nh h 4.Các y u t ế ố ả 5.Đ nh h ướ ị 6.Qu n lý môi tr ng làng ngh ng? ấ ố ể ế ng phát tri n đ i v i làng ngh ? ề ố ớ Đ a ph ươ ề ở ị ườ ả
